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Post-prostatectomy rising PSA

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Posted 2/23/2018 2:25 AM (GMT 0)
Hello friends, it's been quite a while since I've been on the forum.

Quick recap and update: Family history of PCa made it an easy decision for me to have a robotic-assisted prostatectomy in May of 2009. The post-surgery pathology showed a Gleason of 3+3. No evidence of extra-capsular invasion, and lymph nodes and seminal vesicles were clear. Negative surgical margins. Stage was T2c.

For several years afterwards, my PSA was undetectable, with a test result of "<0.1". Then it became "0.1" at which point I switched to the "ultrasensitive" PSA test. The next group of tests went back and forth in the range of 0.07 to 0.13 for about 2-3 years. Then about 3 years ago, my PSA started increasing, 0.13, 0.16, 0.17, 0.20 and 0.24, with these readings at approximately 6 month intervals. This makes my "doubling time" about 2.5 years.

Now that I've breached the 0.20 mark, I figure I need to start thinking about whether I need to do anything and what that might be. I met with a local radiation oncologist today, and I plan to see a medical oncologist in New York City in the near future. But as part of my research, I came back to the best source of information available, which is all of you guys.

Whereas my grandmother lived to be 96, and my mother is currently 94 and in great shape, I plan to live to be 134 years old, so I'm in this for the long haul. Any advice and suggestions you have is greatly appreciated. Thanks in advance.
Posted 2/23/2018 3:14 AM (GMT 0)
It was only Gleason 6 and you had good pathology, so it is likely that some GS 6 was left inside and is multiplying slowly. The question is, do you want to do anything about it? This article may aid your thinking on the subject:

/pcnrv.blogspot.com/2017/11/myth-gleason-6-never-progresses.html

If you had GS7 or higher, or your pathology was adverse, it would be a much clearer decision.
Posted 2/23/2018 4:43 AM (GMT 0)
Its pretty crazy that with a G6 and a great path, you are looking at a possible BCR 8 years after surgery.

This PC beast is nasty.

Someone on this forum said one can last 40 doublings, with that you will outlive your grandma, even with a 1 year PSADT smile

But I would get it radiated and be satisfied that you did everything you could.
Posted 2/23/2018 6:01 AM (GMT 0)

55 and healthy in NJ said...


Whereas my grandmother lived to be 96, and my mother is currently 94 and in great shape, I plan to live to be 134 years old, so I'm in this for the long haul. Any advice and suggestions you have is greatly appreciated. Thanks in advance.

Yeah, buy some assisted living facility insurance soon tongue

Otherwise, after eight good years, I’d count your blessings and relax. Good luck.

Post Edited (garyi) : 2/22/2018 11:58:33 PM (GMT-7)

Posted 2/23/2018 9:38 AM (GMT 0)
TA thanks for the article on G6 progression. That passes the common sense check for me.

55 sorry you are back in the fight but this is still a disease we don't have to die from. Denis
Posted 2/23/2018 11:23 AM (GMT 0)
Good Morning 55, If it was me I would do the same as you get a good radiation team in place they will probably want to do a scan although probably nothing will show up at your low level. If's it still in the prostate bed area which is a good chance then maybe radiation? JMHO I really don't have any suggestions just want to wish you the best in whatever decision you make.

Larry
Posted 2/24/2018 12:54 PM (GMT 0)
I think you answered your question. If you plan to live until at least your grandmother's age, using your PSA doubling time of 2.5 years, it will double about 13 times. Doubling 0.24 thirteen times gives 1,966. Quality of life at a high PSA may not be good relative to hopefully minor side effects from radiation. Given that you were undetectable for so long, its quite likely that the cancer is still in the prostate area and you have a high chance of "cure".
Posted 2/24/2018 5:37 PM (GMT 0)
Tall,

I think for a lot of our members your paper contains a negative amount of information. They will come out knowing less than they did before reading it. This sounds like a criticism but it isn't. Your paper debunks a number of comforting (but incorrect) certainties and leaves the reader with less satisfying (but accurate) ambivalences.

55 64 and [ mostly ] Healthy,

The only certainty about prostate cancer is that while you remain on the green side of the sod there are no certainties. One always has to make decisions based on so-so info. But it is what it is.

Based on the information you've provided I don't think you need to worry over much. With your favorable post-op pathology -- Gleason 6, negative everything -- and with your PSA rising but not exactly off to the races, I'd say your prognosis is good no matter what you decide to do. So, you shouldn't worry.

That doesn't mean you shouldn't do anything. With your PSA reaching the 0.2 mark this might be a good time to talk to a radiation oncologist or two, just to have a name in your rollodex. I'm fairly happy with my current car but I will occasionally visit a car lot to kick the tires, sit in a car or two and complain about insufficient leg room. I've been driving the same car for 16 years now and there may come a day when it will be handy to know which makes and models I like.

Since you plan to live to 134 you should have a number for a good radiation oncologist. Sometime in the next 70 years you might need to call.
Posted 2/24/2018 6:04 PM (GMT 0)
Thank you Peter and everyone.

Fortunately I belong to a local PCa support group whose leader is very knowledgeable and regularly attends nationwide conferences and symposiums with leaders in the field. As I said in my post, I met with a radiation oncologist, who was referred to me by my current urologist (not the same urologist who did my original surgery). The radiation oncologist recommended the same course of action that everyone else here has mentioned, but he also added what Peter said, i.e., that my individual data is not "urgent" today, but might become so once I hit the century mark, and thus doing something sooner is probably better than later.

In any case, my support group leader advises me to not make any firm decisions without getting multiple opinions, which I intend to do. So my next appointment is on March 13 with Dr. Drake at Columbia/Presbyterian in Manhattan. He is a medical oncologist who specializes in prostate, testicular and related cancers. My group leader has offered to go with me, and of course I will report back here to share the information I receive.
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